Artificial pancreas

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The artificial pancreas is a technology in development to help people with diabetes automatically control their blood glucose level by providing the substitute endocrine functionality of a healthy pancreas.

Different approaches under consideration include:

Approaches[edit]

Bioengineering[edit]

The Bio-artificial pancreas: this diagram shows a cross section of bio-engineered tissue with encapsulated islet cells which deliver endocrine hormones in response to glucose.

A biological approach to the artificial pancreas is to implant bioengineered tissue containing islet cells, or stem cells that could differentiate into such cells, which would secrete the amount of insulin, amylin, and glucagon needed in response to sensed glucose.[1][2][3]

Gene therapy[edit]

Gene therapy: Designing a viral vector to deliberately infect cells with DNA to carry on the viral production of insulin in response to the blood sugar level.

Gene therapy approaches have been used in research, either ex vivo to drive stem cells to become beta cells, or used directly to cause cells that do not normally produce insulin to produce it.[4][5]

Medical equipment[edit]

The medical equipment approach to an artificial pancreas: automatic control of an insulin pump with feedback from a continuous blood glucose sensor

The medical equipment approach involves combining a continuous glucose monitor with an implanted insulin pump that can function together to replace the normal function of the pancreas.[6][7][8]

In September 2016 the FDA approved the Medtronic MiniMed 670G, which was the first approved hybrid closed loop system which senses a diabetic person's basal insulin requirement and automatically adjusts its delivery to the body.[9]

As of 2017 dealing with blood sugar levels following a meal remained a challenge for the field.[6]

Initiatives around the globe[edit]

In the United States in 2006, JDRF (formerly the Juvenile Diabetes Research Foundation) launched a multi-year initiative to help accelerate the development, regulatory approval, and acceptance of continuous glucose monitoring and artificial pancreas technology.[10][11]

Grassroots efforts to create and commercialize a fully automated artificial pancreas system have also arisen directly from patient advocates and the diabetes community.[12] Bigfoot Biomedical, a company founded by parents of children with T1D have created algorithms and are developing a closed loop device that monitor blood sugar and appropriately provide insulin.[13]

References[edit]

  1. ^ Omami, M; McGarrigle, JJ; Reedy, M; Isa, D; Ghani, S; Marchese, E; Bochenek, MA; Longi, M; Xing, Y; Joshi, I; Wang, Y; Oberholzer, J (July 2017). "Islet Microencapsulation: Strategies and Clinical Status in Diabetes". Current diabetes reports. 17 (7): 47. doi:10.1007/s11892-017-0877-0. PMID 28523592. 
  2. ^ Desai, T; Shea, LD (May 2017). "Advances in islet encapsulation technologies". Nature Reviews. Drug Discovery. 16 (5): 338–350. doi:10.1038/nrd.2016.232. PMID 28008169. 
  3. ^ Sordi, V; Pellegrini, S; Krampera, M; Marchetti, P; Pessina, A; Ciardelli, G; Fadini, G; Pintus, C; Pantè, G; Piemonti, L (July 2017). "Stem cells to restore insulin production and cure diabetes". Nutrition, metabolism, and cardiovascular diseases : NMCD. 27 (7): 583–600. doi:10.1016/j.numecd.2017.02.004. PMID 28545927. 
  4. ^ Kuroda, M; Bujo, H; Aso, M; Saito, Y; Yokote, K (2016). "Gene-manipulated Adipocytes for the Treatment of Various Intractable Diseases". Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. 136 (5): 705–9. doi:10.1248/yakushi.15-00262-4. PMID 27150923. 
  5. ^ Handorf, AM; Sollinger, HW; Alam, T (April 2015). "Insulin gene therapy for type 1 diabetes mellitus". Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation. 13 Suppl 1: 37–45. PMID 25894126. 
  6. ^ a b Gingras, V; Taleb, N; Roy-Fleming, A; Legault, L; Rabasa-Lhoret, R (4 July 2017). "The challenges of achieving postprandial glucose control using closed-loop systems in patients with type 1 diabetes". Diabetes, obesity & metabolism. doi:10.1111/dom.13052. PMID 28675686. 
  7. ^ Uduku, C; Oliver, N (October 2017). "Pharmacological aspects of closed loop insulin delivery for type 1 diabetes". Current Opinion in Pharmacology. 36: 29–33. doi:10.1016/j.coph.2017.07.006. PMID 28802779. 
  8. ^ Graf, A; McAuley, SA; Sims, C; Ulloa, J; Jenkins, AJ; Voskanyan, G; O'Neal, DN (March 2017). "Moving Toward a Unified Platform for Insulin Delivery and Sensing of Inputs Relevant to an Artificial Pancreas". Journal of diabetes science and technology. 11 (2): 308–314. doi:10.1177/1932296816682762. PMC 5478040Freely accessible. PMID 28264192. 
  9. ^ "Recently approved devices: The 670G System - P160017". FDA. September 28, 2016. 
  10. ^ Artificial Pancreas Project : JDRF
  11. ^ KMorandi says (2017-08-10). "Insurers can profit while improving the lives of people with type 1 diabetes". STAT. Retrieved 2017-08-10. 
  12. ^ Hurley, Dan (24 December 2014) [1] WIRED Magazine, Diabetes Patients Are Hacking Their Way Toward a Bionic Pancreas
  13. ^ Knutson, Ryan (8 June 2015) [2] The Wall Street Journal, Computer Experts Deliver Insulin to Diabetic Kids